老年反流性食管炎患者口服奥美拉唑的血液系统不良反应

目的 探讨口服常规剂量和疗程的奥美拉唑对老年反流性食管炎患者血液系统的不良反应.方法 我院2000年1月至2010年12月经内镜诊断反流性食管炎的老年患者409例,按年龄分为3组,A组60～ 69岁168例,B组70 ～79岁152例,C组≥80岁89例,组内分别随机分为3个亚组,A1(56例)、B1(51例)、C1(30例)组给予口服奥美拉唑肠溶片,每日2次,每次20 mg; A2(56例)、B2(51例)、C2(30例)组给予法莫替丁口服,每日2次,每次20 mg;A3组56例、B3组50例、C3组29例及以上各组均给予口服硫糖铝混悬液每日3次,每次10 ml.共应用1个月.治疗前1d和治疗后第10、30天检测血常规[包括WBC、RBC、血红蛋白(Hb)、PLT]、凝血象[包括凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血浆纤维结合蛋白(Fn)、D-二聚体].结果 治疗后所有年龄组患者症状都有一定程度的缓解,10 d内3组患者血常规及凝血象均无明显变化,治疗30 d内B1组出现血WBC下降2例,1例PLT下降；C1组6例出现血WBC下降,4例PLT下降；C2组1例出现血WBC下降,2例PLT下降.各组凝血象差异均无统计学意义(P均＞0.05).结论 随着年龄的增长,常规剂量、疗程口服奥美拉唑对血液系统的不良反应逐渐显现,尤其是血白细胞和血小板计数,经停药可逆转,需加以注意.

Clinical observation on hematological adverse reactions of oral omeprazole in aged patients

Objective To discuss the hematological adverse reactions of oral omeprazole administration with convention dosage and treatment course in aged patients.Methods Four hundred and nine cases of reflux esophagitis by endoscopic diagnosis from Beijing Hospital during January 2000 to December 2010 were divided into three groups according to their ages: group A ( 168 cases) aged from 60 to 69 years,group B ( 152 cases) aged from 70 to 79 years and group C (89 cases) aged equal to or above 80 years.Each group of patients was randomly divided into three subgroups,A 1 ( 56 cases),B 1 ( 51 cases) and C 1 ( 30 cases ) were administered with oral omeprazole,20 mg,bid; A2 ( 56 cases ),B2 ( 51 cases ) and C2 ( 30 cases ) were administered with oral famotidine,20 mg,bid; A3 ( 56 cases),B3 ( 50 cases),C3 ( 29 cases ) and all above subgroups were administered with oral sucralfate,10 ml,tid.The treatment course lasted for one month.The clinical efficacy,WBC count,RBC count,the Hemoglobin level,platelet count,as well as the prothrombin time,thrombin time,activated partial thromboplastin time,fibrinogen,Plasma fibronectin and serum D-Dimer were tested and compared after 10-days and 30-days treatment.Results After the treatment,all the patients had alleviated symptoms,to varied extend,especially in subgroups treated with oral omeprazole and sucralfate.After 30 days' treatment,blood WBC counting in B1 subgroup declined to lower than normal values in two cases; PLT counting drops in 1 case; blood WBC dropped in 6 cases and PLT dropped in4 cases of the C1 subgroup;blood WBC counting dropped in 1 case and PLT dropped in 2 cases of the C2 subgroup.Hemoglutination did not show significant change in all groups (P ＞ 0.05 ).Conclusion The hematological adverse reactions of oral omeprasole in aged patients,under convention dosage and treatment course,occured with age increase,especially for blood WBC and platelet counting.